Cindy,

I would say the mothers supply is low and probably needs to be "built up"
with frequent breastfeeding and possibly a herbal galactagogue, depending on
what is availabe in your part of the world.

There are several issues going on here and this is how I interpret your
case:

The baby was probably supplemented in the women's unit because the mother or
grandmother requested it. No because of any proven problems with lactation,
at that stage. Myths abound in Asia regarding colostrum being "bad" and some
mothers I have worked with will not even put the baby to the breast until
the milk "comes in". This initial lack of breastfeeding can obviously impact
badly on milk production.

The mother is probably going to have to supplement after breastfeeds and
slowly wean down the formula as her milk supply improves and she gains
confidence. If you can get her to cupfeed or syringe feed instead of the
bottle all the better. Remember this mother is not only being asked to learn
a new skill but also adopt a different cultural context regarding birthing
mothering and breastfeeding.

If she has to deal with a crying baby between feeds it will further
reinforce the superiority of formula that she may already perceive. One
really needs to teach her the basics of breastfeeding. She is going to need
a lot of support. Don't overload her with changes, she needs time to adapt
and asimilate.

The father needs a rap on the knuckles and a bit of a wake up call. He needs
to realise that when you marry someone you marry their culture as well. It
is absolutely normal in this womens culture for her mother to be there
feeding special foods, it is part of the birthing tradition in this country.
He needs to find common ground with mother-in-law and make things work.

Apart from anything else if he does not attempt to get things on an even
keel my guess is that this attempt at breastfeeding will fail. All the
adrenaline in the womens system (she probably needs and wants her mother
there) can only block the oxytocin. Not good for breastfeeding. She may not
be voicing her feelings to him because culturally she would feel the need to
defer to her husband too.

In Jakarta I use the big star anise which I infuse for 15min and mix it with
ginger tea, as a galactagogue. If you are unable to get fennel tea  or
fenugreek capsules, this seems to work well.

The one hospital I worked in we had a very large multicultural population
birthing there. I would sometimes walk into the unit and as I walked past
one of the rooms, would smell the food and know that we had a new Korean or
Vietnamese women on the floor. The families brought in food, special foods
are part of their birthing culture.

Kind Regards

Mandy O'Reilly
RN/RM IBCLC

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